Uncovering an existential barrier to breast self-exam behavior

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Abstract

The present research applies an analysis derived from terror management theory to the health domain of breast examination, and in doing so uncovers previously unrecognized factors that may contribute to women’s reluctance to perform breast self-examinations (BSEs). In Study 1, when concerns about mortality were primed, reminders of human beings’ physical nature (i.e., creatureliness) reduced intentions to conduct BSEs compared to reminders of humans’ uniqueness. In Study 2, women conducted shorter exams on a breast model (an experience found to increase death-thought accessibility) when creatureliness was primed compared to a uniqueness and no essay condition. In Study 3, after a creatureliness prime, women performed shorter BSEs when a placebo did not provide an alternative explanation for their discomfort compared to when it did. Advances for theory and breast self-exam promotion are discussed.

Section snippets

Terror management theory

TMT (see Solomon et al., 1991, for a comprehensive presentation of the theory) builds from a tradition of existential and psychodynamic theory (e.g., Becker, 1973) to posit that the uniquely human awareness of one’s mortality, in an animal biologically predisposed for self-preservation, creates the potential for extreme anxiety, or terror. People, however, are usually not plagued by the anxiety that death awareness might be expected to engender; research has revealed that, instead, a great deal

Study 1

Study 1 was designed to test whether priming creatureliness juxtaposed with a mortality salience manipulation would affect women’s willingness to perform BSEs. Following the general procedure implemented by Meyerowitz and Chaiken (1987), college women reviewed a pamphlet demonstrating techniques for performing BSEs, and then reported on their intentions to perform BSEs. We included manipulations of mortality salience and creatureliness used in previous TMT research (e.g., Goldenberg et al., 2002

Study 2

In Study 1, the creatureliness manipulation hindered intentions to engage in breast cancer screening only when mortality was primed. However, it seems likely that conducting a breast exam (i.e., for the purpose of detecting breast cancer) has the potential to naturally render mortality salient and thus motivate avoidance of screening behavior when concerns about creatureliness have been activated. Indeed, a recent series of studies by Arndt, Cook, Goldenberg, and Cox (2007) revealed that

Study 3

Although the findings of Studies 1 and 2 offer convergent support for the analysis that existential concerns associated with creatureliness in a context where mortality concerns are likely to be activated can interfere with women’s willingness to conduct BSEs, a more ecologically valid test would be provided by (a) using a sample of women at greater risk for breast cancer, that is, older women, and (b) having women examine their own breasts, as opposed to examining a model. Thus, in Study 3 we

General discussion

Three studies support the hypothesis that women’s concerns about their creaturely and mortal nature can create discomfort and undermine willingness to engage in BSEs. In Study 1, the juxtaposition of mortality and creatureliness reminders reduced women’s intentions to conduct BSEs. Study 2 moved beyond self-report intentions and showed that creatureliness priming reduced breast exam behavior on a breast model (an experience found to increase death thought accessibility). Study 3 demonstrated

Conclusion

While there is clearly more work to be done, consistent findings across three studies suggest that an existential perspective is relevant to BSE behavior. Although more traditional health models have made significant inroads toward elucidating factors that can pose barriers to breast cancer screening, the current perspective can broaden the current understanding by considering the unique nature of threats associated with concerns about mortality and creatureliness and the often non-rational

Acknowledgments

This research was supported by NCI Grant R01 CA96581. The authors wish to thank Judy Olson and her staff at the St. Luke’s MSTI Breast Care Services and Cindy Clark of the Department of Nursing at Boise State University for their assistance on this project. Additional thanks go out to Kim Markowski and Robin Nelson for their data collection efforts and Liesl Milan for data collection and literature review. We would lastly like to acknowledge Rob Turrisi of the Prevention Research Center and

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